Wodonga – Central Medical Group
Central Medical Group
Central Medical Group has serviced the Albury Wodonga community for over three decades. Offering the full range of GP services, the practice has 14 doctors, (six practice principals, five GPs, three GP registrars), eight practice nurses, care plan coordinator, clinical services administrator, general manager and administration staff.
The patient demographic of the practice is diverse. There is a focus on family medicine and obstetric care, with seven GP Obstetricians within the group, five who provide full obstetric care and shared care obstetric services.
A chronic disease management program is enhanced by a Diabetes Clinic including the services of a diabetic educator, specialist nursing practitioners and coordinator of chronic disease management plans.
Various GPs have specialty training or special interests in mental health, counselling, family therapy counselling, hypnosis, sexual health, drug and alcohol counselling, paediatrics, women’s, men’s, adolescent & children’s health and skin cancer medicine.
In addition there is a skin check clinic, immunisation clinic and the practice provides routine medical care to a number of aged care facilities.
In 2016/2017 the building was re-furbished adding new training, consulting and waiting rooms to support the growth of the practice. The adjacent building was also re-furbished to house Physiotherapy and Pathology services.
Albury Wodonga Health has two campuses, Albury and Wodonga. They offer acute, sub acute & primary care hospital – major trauma centre. 337 beds. 62,943 emergency presentations 2016/17. The Wodonga campus includes Maternity Unit, special care nursery (AGPT ARST Skills Post).
The Maternity Unit has 1600 – 1700 births annually. The unit comprises of six fully equipped birthing suites, 30 dedicated maternity and gynaecology beds, a 14 bed Level 2 Special Care Nursery and a Midwife Care Program. Average of 135 deliveries per month. Special care Nursery has up to 470 admissions annually.
Mercy Health is a subacute hospital offering palliative care, geriatric evaluation and management, transitional aged care, aged care assessment, community therapy and inpatient rehabilitation programs. They do not provide acute health services.
Albury Wodonga Private Hospital is run by Ramsay Health and provides an extensive range of inpatient and day patient services all located on site.
Murray Valley Private Hospital, run by Ramsay Health, is a 32 bed facility providing comprehensive inpatient, day patient and outpatient rehabilitation and sleep study services.
The Border Cancer Hospital , run by Ramsay Health, the Albury Wodonga Regional Cancer Centre is a purpose built integrated cancer centre which provides best practice cancer care through a public / private partnership with Albury Wodonga Health.
Central Medical Group has a long history in GP training, taking on their first registrars in 2003 with the beginning of the Bogong Regional Training Program. The six principal GPs are qualified AGPT supervisors. Doctors in the practice have GP educator and examiner roles with the RACGP, ACRRM, the Australian Medical Council and the MCCC GP Training program.
Central Medical Group supports its registrars throughout the AGPT program with formalised teaching and on site supervision. The practice has a dedicated Director of Medical Services responsible for the continuing professional development of all staff including the supervision and coordination of the registrar program.
On appointing the Director of Medical Services, the practice completed a review of its training program for registrars and medical students. Changes implemented included the development of a more formal teaching structure and sharing the supervisor role between the senior GPs. To this end, the practice allocates one supervisor for the registrar per session. Allocated time is blocked out for the supervisor to adequately cover supervision requirements, recognising that supervision takes a significant amount of time and skill.
The practice holds weekly clinical meetings with case presentations presented by staff members and visiting health professionals. A formalised teaching structure and tutorial program, supplementing the AGPT program, has been developed in house, including lesson plans, prescribed reading and OSCE style and KFP style case discussions.
Additionally the registers have access to various medical and educational events including hospital rounds, clinical presentations, tutorials and information sessions. These are coordinated by the hospital (Albury Wodonga Health), the Border Medical Association and other groups within the medical community.
A range of GP procedural opportunities and extended skills training are available within the practice. Procedural terms at Albury Wodonga Health include Obstetrics – Advanced Diploma in Obstetrics, Anaesthetics, Palliative Care and Psychiatry.
DR DAVID TILLETT
Central Medical founding practitioner, Dr David Tillett spent his intern and registrar years in Adelaide and Alice Springs before commencing general practice in Wodonga in 1987. Initially working in a two doctor practice, Dr Tillett purchased the practice on his partners’ retirement. In 1990 Dr Tillett was joined by Dr Allison Green and in 1993 the pair purchased the current building in order to take on a third partner.
Dr Tillett is a GP Obstetrician. He has special interests in counselling, hypnosis and family and systems therapy. He has completed a Diploma in Clinical Hypnosis and completed training in Family and Systems Therapy.
Having over three decades of experience in general practice, Dr Tillett explained a fundamental priority for him has been to ensure the practice has a robust business plan and sound governance structure to sustain the practice and enable the successful growth of the organisation.
“Good management and good governance has been a priority of mine from day one… It is something that is really important to me….. We have worked really hard to evolve our structure over time. It has been a learning curve for everybody.” said Dr David Tillett.
Dr Tillett recognises the importance of comprehensive planning and joint decision making. He described an organisational structure where the practice principals have various roles and responsibilities via membership of specific sub-committees, overseen by the governance group. These are paid positions, recognising the time factor involved and the value of the contributions made by practitioners in each role.
The second tier of the organisational structure is the management group. This group deals with the day to day running of the practice, and implements the “grand plan” of the governance group. The management group includes the general manger, a clinical services manager and customer services manager. Dr Tillett noted this level of formality was necessary given the size of the organisation and the complexities of general practice management.
“In the old days when it was just Alison and myself, we could make decisions in the corridor between seeing patients, but now it’s just too big an organisation for that kind of management style.” said Dr David Tillett.
Dr Tillett explained the participation of all partners in governance committees provides a growth pathway for associates towards succession, and provides opportunities for professional development and developing interests outside clinical general practice.
As part of their experience at the practice, registrars come to understand the organisational structure in place and how the practice works from a management perspective. Dr Tillett described this as an important component of registrar training, to understand the concepts of governance and management and how this effects the day to day running of the business.
Sustainability of the GP workforce has been an important focus for the practice. Dr Tillett ascribes a work life balance as the key to longevity in general practice. The ethos of the practice is to have a healthy workplace which is achieved in part by ensuring practitioners have a balanced lifestyle and adequate workplace flexibility to facilitate this.
“We have been really careful to try and promote a balance for our doctors… because it has got to be an attractive proposition for them to come here and want to stay here, but also because I think it makes better doctors. We work hard to offer flexibility, both in terms of working hours and in terms of giving people lots of opportunities to do other things outside of general practice.” said Dr Tillett.
Dr Tillett attributes this ethos as being partly responsible for the groups’ success in attracting and retaining general practitioners.
A highlight of general practice for Dr Tillett is the privilege of being involved in longitudinal relationships with his patients, often over several generations. He explained the interaction between patient and doctor is often more important than the medicines prescribed and that one of the most interesting things about general practice is that you never know what you are going to see next.
DR ALISON GREEN
Dr Alison Green graduated from Sydney University, completed intern and registrar training in Sydney and Coffs Harbour then, following a period of travel, made the decision to move to a regional area where her partner had family connections. On moving to Albury Wodonga, Dr Green worked in obstetrics completing the Advanced Diploma training with the RANZCOG. Dr Green was the second GP at Central Medical Group, joining as Practice Principal in 1990.
Dr Green reflected that during the infancy of the RACGP GP training program, the organisation had little support for GPs outside metropolitan areas, was city centric and had little awareness of workforce issues in regional rural areas.
“I wanted to obtain the RACGP Fellowship while working in Wodonga. My supervisor, who was in Sydney, rang and said – you haven’t been attending the Tuesday night tutorials at Royal North Shore Hospital.” said Dr Alison Green.
Experiencing firsthand the limitations of metropolitan based training motivated Dr Green’s involvement in regional GP training organisations. Dr Green is a past board member of the now defunct Bogong Regional GP Training Network, is a current director on the Board of MCCC GP Training and is a Graduate of the Australian Institute Company Directors.
“Being based in the regions is why the RTO’s have been so successful. They understand what happens on a local basis and the need to have relevant employment pathways, training opportunities and training support to retain the medical workforce in regional areas.” said Dr Green.
When looking at the growth of the practice and the decisions made along the way by the practice principals, Dr Green identified the focus on lifestyle as the lynch pin to sustaining the workforce and retaining their registrars.
“What makes our practice attractive to a lot of registrars is that the associates, the owners of the practice, have always done other things – apart from being doctors. That has been very important to us. We focus very strongly on a work life balance.” said Dr Green.
Dr Green explained the majority of practitioners work around seven face to face sessions per week, allowing time for involvement in other aspects of the general practice and for the pursuit of outside interests.
When asked what is unique to Central Medical, Dr Green advised we get on! Really – it is crucial.
“We have strategy, we have policy but essentially underpinning all of that is that we are all singing from the same hymn sheet… We all have a similar reason for doing what we do and we all have similar goals. Formalizing things has helped sustain that.” said Dr Green.
DR LAURA SHOBBROOK
Dr Laura Shobbrook grew up in the Albury Wodonga region, attended a local high school, had no family background or connections to the medical field, but always wanted to be a doctor.
As part of her undergraduate degree at Monash University, Dr Shobbrook undertook a GP placement in Wodonga confirming her decision to pursue a career in general practice. She completed GPT 1, 2 and 3 at Central Medical Group Wodonga and Yackandandah and ARST & extended skills posts at Albury Wodonga Health, obtaining the Diploma in Obstetrics in 2013. She joined as practice principal in 2015.
“One of our partners, Laura Shobbrook, is distinguished by first being a patient here, then a medical student here, then a Registrar and now a partner. …. That kind of growth within the practice from student right through to senior doctor has been fantastic for us.” said Dr David Tillett.
Being a new parent, Dr Shobbrook appreciates the work place flexibility Central Medical offers. She explained she consults for six sessions per week. The on call commitment is not onerous as the practice shares the on call roster with two local clinics. In general, GPs cover two or three weekends per year and one week night per month.
Dr Shobbrook enjoys all aspects of family general practice, but being a young, female GP, the patient cohort she treats is predominantly young women and families. She provides ante natal and post-natal care at the clinic, but is not on the roster for obstetric care at the hospital.
“I tend to see a lot of families and children and young women who are my age. I enjoy working in women’s health. I like the family doctor feeling, the vibe around that.” said Dr Laura Shobbrook.
Each practice associate has a specific role within Executive Group. In her role as Director of Medical Services, Dr Shobbrook’s responsibilities include staff professional development, health and well-being and recruitment.
Dr Shobbrook is responsible for the coordination of the registrar program. Having been a registrar within the practice herself, she has a unique perspective. Dr Shobbrook contributed to the practices review of their registrar program, implementing various modifications, including the development of an extensive induction package and an in house tutorial program to supplement the RACGP curriculum.
“My observation was we had some registrars who were falling through the gaps or had big knowledge gaps or significant areas where they were not getting things covered. Often that would not come to light until quite late in their training, which was an issue.” said Dr Shobbrook.
In describing what the practice does to attract registrars, Dr Shobbrook explained the practice relies greatly on ‘word of mouth’ from previous registrars who have had a good experience. She recognised that the structure the practice has put in place around the registrar training program has shown benefits in the increased number of registrar applicants to the practice in recent years.
For Dr Shobbrook, highlights of general practice include the workplace flexibility and diversity of roles that flexibility allows. Of particular importance are the relationships with the patients and the journey undertaken together that are most worthwhile.
“I like family practice – it’s like being a collector of families. …. I have entire families where is see from the grandparents down to the great grandchildren, and everyone in between. I really like that continuity and the family feel. Having the journey with the patient – good and bad news. It is such a privilege to be able to do that with them. You can’t beat that.” said Dr Shobbrook.
DR JONATHAN DA SILVA
Toronto born Canadian, Dr Jonathan Da Silva came to medicine via a circuitous route. Dr Da Silva completed an undergraduate degree in Biology, post graduate studies in public relations and worked in corporate and government organisations in public relations and crisis management in the pharmaceutical industry. At 28, Dr Da Silva made the decision to change his life, shifting his professional focus to medicine and his location to the other side of the world!
“I was 28 – I thought, if I am going to do this – I’m just going to change everything. I wrote my entrance exams, packed everything up and moved to Australia.” said Dr Jonathan Da Silva.
Dr Da Silva moved to Australia in 2008, obtaining his MBBS in 2011 at University of Queensland. On graduating, he completed his internship at Caboolture then moved to Victoria where his partner has family connections. Dr Da Silva completed registrar rotations at Bendigo and Albury Wodonga in emergency, psychiatry, critical care, ICU and oncology. He had commenced study for the anaesthetics primary examination, but ultimately chose general practice for the flexible life style options this offered.
“Potentially, general practice gives you more options. Depending on how you do it. It gives you the ability to move around if you want. If you want to pursue teaching, or policy development, or something procedural, you can do that. You can modify general practice to suit your strengths and interests.” said Dr Da Silva.
Dr Da Silva commenced the AGPT Program in 2015, joining Central Medical Wodonga. On being awarded RACGP Fellowship in 2017, he continues in his position as general practitioner at the clinic.
Dr Da Silva explained the whole team at the Central Medical prioritises support and supervision of the registrars. As a former registrar and now as a practice GP, he identifies ongoing activities such as tutorials, weekly clinical meetings and case presentations as being valuable in the ongoing professional development for all staff and seeking advice and sharing knowledge and ideas is welcomed and embedded in the practice culture.
When working towards the RACGP Fellowship examinations, Dr Da Silva explained that initially he struggled with the Key Feature Problem (KFP) component of the examinations. He explained his supervisors at the practice were able to provide specific support, focusing on the exam style and how to think and respond to what the questions were asking.
“The Supervisors were really supportive and really good and helping me target how to focus on how I think. There was a targeted focus on the exam style. They really helped me learn what the questions were asking, how to answer them and how to think in that way.” said Dr Da Silva.
For Dr Da Silva “sharing the journey” with his patients is of primary significance. He “loves talking to people” and recognises this as an important component of his practice.
“You can’t help someone…. you can’t understand them without talking with them. It’s the big difference between talking to someone and talking with someone. I think general practice allows me do that…. To go on a journey with them. You’re not necessarily hand holding, but you’re just walking along the journey with them.” said Dr Da Silva.
With special interests in mental health, counselling and sexual health and particularly sexual health relating to the transgender community, Dr Da Silva has completed further training in counselling and the treatment of mental health issues through the Black Dog Institute and by attending workshops through local Murray Primary Health Network.
He has commenced a Master of Medicine (Sexual Health & HIV) with the School of Medicine at the University of Sydney, currently completing the counselling pathway. He plans to undertake further study relating to sexual health, HIV, Hep B and Hep C.
“People are often embarrassed to discuss sexual health. Sometimes people will come and almost secretly ask for a sexual health check-up. So it’s nice that I can normalize this for people. It’s important to normalise discussions around sexuality and sexual health issues.” said Dr Da Silva.
Dr Da Silva’s patient cohort is varied. As well as general family practice, he predominantly sees men’s health, adolescents, adolescent mental health, Veterans, paediatrics and older patients. He supports the Clinic’s approach in recognising diversity and providing a safe place for all people to seek treatment and services without judgement.
Dr Da Silva is currently Secretary of the Border Medical Association (BMA). This is an organisation for local medical practitioners, which encourages collegiality amongst the profession and facilitates both professional and social activities. The BMA has developed a medical recruitment task force and is working with public and private hospitals and the Primary Health Network to meet workforce needs for the region.
Dr Da Silva explained one of his roles with the association is to develop a registrar network throughout the region with the aim of supporting registrars and creating training pathways, social connections and employment opportunities locally.
For Dr Da Silva general practice is about connecting with people. For him, general practice provides a great sense of community, an opportunity to know that community in depth and at times having the satisfaction of knowing you have made a difference to people’s lives.
“For me it’s the connections. I like people – You know the patient or someone who knows them – it can be a blessing and curse all at once, but you get to know the person, their family, their families’ family. You see them and experience with them those connections.” said Dr Jonathan Da Silva.
DR HAYLEY DYKE
Dr Hayley Dyke comes from the NSW south coast, attending high school in Kiama. She completed a pre-med, undergraduate Bachelor of Medical Science degree at Wollongong University, followed by a four year post graduate degree to obtain her MBBS in 2015.
Dr Dyke had not considered doing medicine, having a particular love of history, but a supportive high school teacher suggested she consider the pre-med degree offered at Wollongong as an option. Dr Dyke explained it was her history teacher who showed her how to get into medicine!
A general practice placement in Forbes (central west NSW) as a medical student cemented Dr Dyke’s decision to pursue rural general practice.
“It was an amazing practice. The GPs managed the small hospital there. Our accommodation was across the road. As soon as we heard the ambulance or the helicopter, we would go straight in and see what was happening. It was a wonderful experience with lots of hands on.” said Dr Hayley Dyke.
Dr Dyke commenced her AGPT training, completing PGY1-2 at Albury Wodonga Health doing paediatrics, emergency, obstetrics and gynaecology placements. In addition, she was involved (as a volunteer) at the NSW University Rural Clinical Health School based at Albury Wodonga Health, mentoring medical students and organising small tutor groups practicing history taking and examination techniques.
Dr Dyke joined Central Medical Group Wodonga as a GPT1 Registrar at the beginning of 2018. She had decided that the hospital system was not for her and preferred general practice where she could be more involved in the relationship with her patients.
“In hospital it is very medicine centred. You tell the patient this is what we are going to do, whereas in general practice you tend to approach it differently. You get the patient really involved in their care.” said Dr Dyke.
Dr Dyke commented that like most ‘very new doctors, for her, starting in general practice was overwhelming, particularly trying to “know what you don’t know”.
She explained that Central Medical has an in house orientation package which they have created for new staff.
“The orientation package is on a USB stick. It is a program of three hours which the practice has designed for you to work through. It is separated into modules… it is just incredibly comprehensive. Now several months later I need to go back and look at it again, when everything is in context.” said Dr Hayley Dyke.
Dr Dyke attended the MCCC GPT1 Orientation Workshop, then at six weeks into the program, the MCCC Core Skills Workshops. She explained registrars were able to meet with colleagues, have a ‘group de-brief’ and after having settled into their placements, were able to make better sense of all the information with a clearer perspective and understanding.
In considering her future following the GP training program, Dr Dyke has commenced a Masters in Public Health with James Cook University. She is interested in refugee and Aboriginal health.
In choosing to stay in the Albury Wodonga region, Dr Dyke explained that like many regional areas, it was important to get involved in the community. She described the practice itself as very welcoming and friendly and has taken the opportunity to join local groups and make herself at home.
She has been involved in the Border Association for Hospital Medical Officers, a group formed for social and professional purposes and attends the local Border Medical Association events, stating participating in these organisations was “like a ticket into a new social network”.
When asked what makes general practice worthwhile, Dr Dyke displayed a special thank you card presented to her by a young patient.
“You just connect with your patients in such a way that you don’t get in any other job. It is such a privilege to be intimately involved in other people’s lives – it’s just that connection.” said Dr Dyke.
Dr David Tillett
MBBS 1983, DRANZCOG, FRACGP
Founder Central Medical Group 1987
Chairman Associates Governance Group
Dr Alison Green
BMed (Sci), MBBS 1987, DRANZCOG, FRACGP
Practice Principal 1990
Graduate Australian Institute Company Directors
Past Director Bogong Regional Training
Current Board Director – MCCC GP Training
Dr Laura Shobbrook
MBBS Monash University 2009
FRACGP 2014, DRANZCOG
Practice Principal 2015
Dr Jonathan Da Silva
MBBS 2011 University QLD
Dr Hayley Dyke
MBBS 2015 University Wollongong